CHAPTER THIRTEEN

London, August 1854

1

Snow looked up from his papers, surprised to hear the bell so late at night. He wasn't unhappy to be distracted. His concentration was gone. For the past fifteen minutes he'd been staring at figures while dreaming first of Sophie's thighs, then of sleep.

Mrs. Jarrett knocked sharply on his study door in one of her most eloquent raps. He heard it all too clearly. "See what I have to put up with? And just going to bed, too." Her hair was in papers under a bursting cap. Carpet slippers, down in the heels, jutted out from under her skirt. She was in a fit of annoyance. Snow paid no attention. He reserved all his interest for the guest.

It was Sir Philip Constable, the deputy minister of public health. The same man who'd hinted at an invitation to the Royal Society last winter. Snow had almost forgotten. Almost, but not enough to want to tell his father that the offer hadn't come through after all. His father thankfully hadn't asked about it in his few letters since last January.

Snow turned his eyes back to his notes for the briefest moment before rising, long enough to allow him to enjoy the gratification of finally getting his invitation. Why else would the man have come?

"Good evening, Sir Philip." He tried to sound surprised, puzzled, modest; all the things he was not.

The man stood in the center of the room holding his hat and gloves, looking dazed, as if he had stumbled off an omnibus in the wrong part of the city.

"Can I offer you something?"

Constable stirred himself and looked around. "No, nothing, thank you.

His smooth dark hair had receded farther since the one time Snow saw him, and his hands swelled around gold rings. There was a marzipan look to him of too many cigars and long days in soft chairs. His gliding brown eyes could have been sinister but were merely withdrawn. Under his arm was a copy of The Times.

We're probably the same age, thought Snow.

He seemed to recollect himself. "Snow, I must speak to you about these letters." Sir Philip held out the paper in explanation.

Snow pulled his shoulders back and flared his nostrils. The man talked as if he were addressing his groom. Snow couldn't fool himself; this was no preamble to any invitation.

"What letters do you mean?" Snow pulled out a chair and gestured for his guest to sit.

"Surely you've read the paper today?" Seeing Snow's bewildered look, he opened the paper and turned it back to the correspondence section.

"Here, see for yourself." Snow made no move to take it. "Shall I read one to you then?"

Snow was still angry and now confused, too, so he simply nodded.

Sir Philip's eyes scanned the sheet. "Ah, here it is.

If a certain doctor would spend more time seeing patients and less spending the crown's money on the useless daily annoyance of private citizens, we could all rest easier. His ridiculous questioning of bereaved families is a public insult.

Unsigned

Snow had no idea whether Constable was in sympathy with the writer or not. Why on earth come here to read these things?

He held his head to one side, eyebrows drawn together. A suspicion was beginning to dawn on him.

"And here's another," continued Constable:

Dr. John Snow should give up. The cause of cholera is too varied and treacherous for any one scientist to define. It were a far better thing for us to return to the public religious fasts of a decade ago, with the queen's support, than to rely on this claptrap they call the study of medicine. 

A Devoted Member of the Presbyterian Church

"Are you beginning to see?" said Sir Philip. "At the House of Commons tonight the minister of health expressed concern about the letters. I've just come from a night session." At this his eyes looked away from Snow's for a moment, then back. He shifted the gloves in his hand.

It was a moment before Snow could speak. "Well now, Sir Philip. The minister isn't always so solicitous. You are the deputy minister now, I understand."

Constable bowed slightly.

"You must thank him for me. I appreciate his sympathy, Sir Philip, but public service is often open to hostility. I wouldn't give the letters another thought." Snow carefully moved a list of cholera addresses on his desk from one pile to another.

Sir Philip's eyebrows contracted like the wings of a crow thinking of flying off. His right hand squeezed tightly around the lavender suede of the gloves. It was then that Snow noticed the man's fingernails; each had been eaten away by fungus to the size of a grape seed. Onychomycosis. Snow restrained himself from peering over for a closer look. The man must have been in the tropics.

Constable saw his stare and self-consciously put his hands in his lap. "Perhaps you're not aware, Dr. Snow, that the minister has appointed an officer and a committee to look into these very matters?"

"What?" asked Snow, opening his eyes wide in mock innocence. "To look into the letters? Very kind of him, but —"

"Not the letters. The water supplies. The cholera. The disease rates."

Snow still looked at him, face blank, refusing to become defensive.

Constable was forced to go on. "I'll be blunt. The minister is distressed that you've made allegations against his reform policies. He doesn't believe such connections can be possible. They've begun their own cholera inquiries, similar to yours but on a much larger scale, of course.

What allegations? What reform policies? Snow knew he'd never said anything of the kind. He rose and walked to the window, put his hands flat against the glass. "Yes, I read that such a plan had been made. But that was weeks ago. I looked for the survey workers around the sicker areas. Have they finished? Did you bring a copy of the report for me to read?" He turned back to Constable.

"The surveys haven't started yet. There are — complications to work through." The lower lid of Constable's right eye began a tiny quiver that only a doctor would have noticed.

"Then they'll be wasting their time and the public funds." Snow snatched up a piece of scrap paper and crumpled it. "People forget, records are lost. A worker who loses his family will hardly remember in two weeks what they ate ten days before they died. Assuming you can find him, of course."

"The minister is aware of all the details, Dr. Snow. I must be plain about the reason for my visit. He has asked that you return to your practice and cease your survey efforts. You must get requests for chloroform treatment every day. Surely it is enough to keep you busy."

Snow couldn't believe what he heard. "But that's impossible, Sir Philip. These house-to-house questions provide the details essential for my project."

"You don't understand. Your project interferes with that of the minister, who has a Royal Sanction for Dr. Farr. The man's miasma theories are proving to be sound."

"The queen has asked him to do the work, specifically?" Memories flashed across Snow's mind, of the queen's exophthalmic eyes turned up in agony while he prepared the chloroform for her labor pains. The expensive beeswax and fresh flowers hadn't been able to overpower the smell of blood and amniotic fluid. She had asked that Snow refrain from using his chloroform mask, and that he use instead a few drops of the fluid on a handkerchief. It seemed less a violation of God's will, she had said. Snow knew her descent into unconsciousness was less controllable with the soaked handkerchief, and therefore more dangerous, but he didn't want to enter into a debate with her. The handkerchief, despite all Snow's publications and efforts, was still more fashionable than his invented inhalation apparatus. Ladies said the apparatus left a mark on their face. Within an hour of Snow's arrival, the royal doctors had easily and safely delivered her of Prince Leopold, despite her tiny frame.

Constable went on. "Not exactly. The queen didn't ask him herself; Her Majesty hasn't been well and it wasn't the time to disturb her. But her closest advisors —"

"It's out of the question that I should stop. You don't know much about how a scientist works if you even suggest it."

Should he confront Constable with the threats? Who could they be from if not from this source? But caution made Snow silent; he didn't want Sophie thrown at him as an accusation.

Besides, if he were mistaken, he would sound like a madman. Who would threaten a London doctor with bodily harm, just for doing his research? He said nothing.

Both were standing now, facing each other and as close to a fight as men with clean cuffs and gold watches could get. Snow found that his fists were clenched.

Constable was the first to break the locked stare. He sighed. "Dr. Snow, believe me, it would be in your best interests to listen to me. I was commissioned to make certain, well — offers, if you were to comply. That appointment to the Royal Society. I didn't forget it, you know. It could be made certain. They could use a man like you."

Snow's anger kept him from speaking. Forget the invitation, he thought. He walked to the library door and opened it hard enough to hit one of the bookshelves and set all the bottles of Thames water rattling. Sir Philip had no option but to go.

When his footsteps died away, Snow turned back to his lists, figures he'd gotten just that morning from a back office at the Registrar General, in the Board of Health's own building. He had the address of every cholera case reported to the board in the past seven days, all two thousand of them. If the director really wanted to keep Snow away from the data, he should have talked to his clerks. They'd been most helpful, and offered Snow everything he wanted, even copied out some of the things he was too busy to do himself. 

2

Snow didn't sleep well. The bedclothes seemed heated. Even after throwing them to the floor he felt as if he'd been running a foot race and losing, gasping to keep up. He tried mental exercises to get his mind off Sir Philip's warning. Nothing helped. He would imagine a field of barley in Yorkshire, or a stream falling over tumbled rocks, and almost before he was aware of it Constable would be there too, crushing the foliage, admonishing Snow, cramping his thoughts, fueling his anger.

It was the anger that kept him awake. He had decided that Sir Philip must be behind the scheme, after all. How dare they? Sneaking after him with cheap threats, like a bunch of American gamblers. His entire being felt dirtied by it. It wasn't as if he were an unknown medical student pursuing a ridiculous notion. He was John Snow, he'd published articles, he'd given chloroform to the queen. It just didn't make sense.

And he wondered about those reforms Constable was so anxious about — the man must have meant sewer reforms. That's why they were digging up Golden Square.

The next morning he woke at seven after three hours' sleep. His knees were weak. He wobbled like an old man to the window and looked out, checking the sky, checking the wind, looking for any hope of a cooler day. But what he saw made him forget the weather. Across the street, leaning on a lamppost and reading a paper, stood a man with the posture of a laborer, wearing a plaid suit and a stiff shiny hat. The man turned a page of the paper and glanced at the front of Snow's house, then pulled out a watch.

They must have decided that the dwarf was too conspicuous.

The questions returned to his mind — why would the Board of Health waste a shilling of their funds to bother with John Snow? Well, they'd have to do better than that. He smiled to himself. Lately he had left his house at eight every morning, but today it was to when he went through the untidy kitchen into the area back of the house. He ripped out the side seam of his jacket climbing over a wall into the alley. When he reached the corner of Sackville Street he looked down toward his address and sure enough, the man was still there.

Eight o'clock and it was already hot. His lack of sleep sat on his shoulders like an organ grinder's monkey, making his thoughts weave drunkenly from sense, to memory, to excited new ideas. A thread of anger against Constable and the Board of Health was woven throughout.

He hadn't gone two streets before he caught the sounds of yelling crowds. He turned a corner and saw that the street was full of workmen running toward Golden Square. They carried shovels and picks. One snatched up a piece of broken cobblestone and hurled it randomly at a house window, and glass shattered loudly.

Snow felt the damage personally, as if the man had spit at him. But he also had an adventurer's urge to chase the crowd, see the commotion, the fire, the murder, whatever small catastrophe it was they joined. He gave in to the craving and followed them.

The mob was yelling under the plane trees in Golden Square, around the digging site where he had seen the dead man so many weeks ago. It was a strike. Workers from all around the neighborhood had heard of it and joined in. Red clay caked the shoes of a few who stood in the ditch, still shoveling away at their task, stolidly ignoring the strikers. They stood like grave diggers, waist deep in the earth.

Shouting voices rained down on them like stones.

"Yah, you're digging up the plague pits. Pulling up old bones. Killing us all!"

"See how you feel when your wife and brats die of this thing. Stirring up these plague pits, it's shameful!"

One by one the diggers lost their nerve and stopped, climbing out over stacked pipes and equipment and slinking off through the crowd. Finally only one still kept at it.

He was a few inches taller than most and looked vaguely familiar to Snow. The only thing Snow could focus on was a faint sense of unease on seeing his face.

The man's persistence infuriated the strikers. One with mud-caked hair and the narrow and powerful shoulders of an ape leapt into the hole and grabbed the man's shovel. The digger struggled to keep on, straight-faced, almost holy, as if he were laying the foundations for a new chapel.

"Let me get on with my work, man." He spoke from the side of his mouth. Sweat dripped from his chin and caught the sun.

The bully yanked the man's shovel free and hit him lightly, almost in play, on the side of the head. The digger staggered, one hand to his head, then took back the shovel and resumed digging.

"Good work, ain't it, filling the air with disease and muck." Just then the crowd parted like a small Red Sea to let through a gentleman in a top hat. Snow was astonished to see it was Sir Philip Constable stood at the edge of the pit with the bullish authority of a slave owner.

"What's the trouble here? Why aren't you working?" His question was bellowed rather than asked. Snow hadn't known he had anything to do with these works.

The man in the pit jammed his shovel into the earth. "We're digging for new sewer lines, sir. Some folks think it's here what the plague bodies was buried, long ago. Stirring up bad air. Bringing on the cholera."

"Anyone who believes that is a fool. It's nonsense. All those facts were investigated long ago, when they planned the lines. You were hired to do a job here, so get on with it. Leave such things to higher minds." Sir Philip's shout faded a bit and he slipped a look at the angry crowd and then back to their spokesman, the monkey-shouldered one. "All of you, get back to work immediately or you'll be sacked."

"It's easy for you to say, as hasn't got your family and friends dying around you. Go to work yourself. We'll give you work."

The man shoved Sir Philip, who stumbled and fell into the ditch. Two of the rioters closed in on him with their fists. His tall hat fell off and served as a football for others.

Snow's suspicions faded as he rushed forward. After all, Constable was a government official. He couldn't have anything to do with those rough minutes in the alley.

"Stop it, leave the man alone." Snow's voice startled himself, as well as the aggressors, who backed off. No one looked as surprised as Constable.

Snow kept up the heroics. "Someone, run for the police," he shouted. At the word "police" most of the crowd began to back off and within a minute Snow and Constable were left alone except for a few stragglers.

Snow extended a hand to Sir Philip and helped him out of the ditch. Once again he noticed the man's fungus-eaten fingernails. The only other case of onychomycosis Snow had ever seen had been on the feet of an assistant to an explorer up the Nile, whose nails had disappeared entirely. He ignored it this time and helped Constable up and tried to brush off some of the mud. It was hopeless.

"Are you at all hurt?" asked Snow.

"No, no, it's nothing." Constable fingered his bruised cheek. "I'm afraid my coat is rather battered, though. What ruffians! How lucky you were here."

Didn't Constable remember that Snow lived near here? He was acting as though last night never happened. Snow decided to say nothing. Sir Philip began again to have the distracted look he'd had the night before, as if he'd already forgotten that he was knocked into a ditch. His argument with Snow last night seemed completely abandoned.

"I live just a few houses away, if you remember. Would you like to come to my house and wash?" Snow hardly thought Constable would accept, and he didn't relish the thought of more time with the man. But it was hard to truly resent anyone covered in mud. Pedestrians returning to the street began to stare.

Snow thought he'd give Constable a way out of having to come to his house. "On second thought, I suppose you ought to wait for the police?"

"I suppose I could, but I don't think I'll enjoy reading about myself in the papers tomorrow. ‘Mud-spattered MP found off Oxford Street.'  Perhaps we should leave while I'm still anonymous."

Snow shot Constable a quick look, trying to detect some reason for the change of attitude. He saw only a polite mask. They headed for Sackville Street. There was an awkward silence which Snow finally broke.

"You spent time in the colonies, I take it?"

Constable glanced up in complete surprise. He didn't look happy to be asked this question. "Yes, in the Indian Army. When I was much younger. That's all behind me now." He frowned and was silent for a moment. "You noticed my fingernails, then?"

"A doctor does tend to see these things. I hope it's not too uncomfortable?"

Constable cleared his throat. "Only in the early stages, years ago. Now I never notice it."

Snow thought he had better change the subject. "Is there any truth, Sir Philip, in this plague pit theory?"

"I'd have thought that to be more in your line, Dr. Snow."

"I don't mean the question of exhumed corpses causing the disease. That's not possible, I know. But the location; where were the bodies buried? Near here?"

"A historian worked on it when it came up before. Along with Dr. Phineas Greeley — you know him?"

Old Green Eyes Greeley from Guy's. Snow wasn't surprised to hear him come into this. All Snow said was, "Yes, he was my teacher at Westminster Hospital."

"Well, he suggested there might be reason to fear, so we had it looked into. The site was far from here, nowhere near any of the new pipe lines."

"Is Greeley a consultant on the project, then?"

"Oh, yes, we were lucky to get him. Eminent in his field of contagion theories. Or so I'm told."

"I know he came up with some useful work before my time. But I haven't seen his recent writing. We travel in different circles." The truth was, Snow thought Greeley a charlatan. He could believe that Greeley might cure society ladies, but he was shocked to hear of his connection with the board. Dr. Farr' s work on cholera, though Snow disagreed with it, was at least the result of hard work. But Greeley had no idea of any kind of scientific method.

The two men reached the house and Snow got Constable settled with a wash basin and a stack of his own clothes. He also changed his own jacket, whose torn seam Constable didn't seem to have noticed. While he waited for Constable to finish, thoughts of Greeley took over Snow's memory.

The first thing that came to mind was Greeley's walk, the way he'd enter lecture theaters with a peculiar bounce of the toes, as though small springs were concealed in his boots. He was a small man; maybe he bounced as an excuse to get up on his toes and look taller.

The main memory, though, was an affair with botched laboratory experiments. As he remembered it now, Greeley never did withdraw his paper from The Lancet. It was some nonsense to do with spontaneous generation, growing amoebas from a jar of water struck by lightning. Greeley's experiment had been funded by one of the new churches, Baptists most likely. When the fallacy had been exposed there had been a touchy year for Greeley and he had almost lost his post at the hospital.

Splashing noises came from the bedroom. What was taking the man so long?

And Greeley thought the plague pits could contain cholera. What trash! Even though Greeley wasn't alone in his theory it was easier to think that one little pink-cheeked man was responsible for such worthless ideas.

The previous night's conversation filtered into Snow's mind. How much did Greeley have to do with all Constable's orders? Was Greeley working on the "official" investigation? If so, no wonder they weren't getting anywhere. Snow remembered Greeley's lecture technique at Westminster; loose papers drifting from the podium, talks canceled a third of the time, and trains of thought drifting off to nowhere.

How much longer would Constable take? Snow was anxious to be off for the day. Now that he had to be careful he wasn't followed, things took longer.

Constable emerged from the bedroom wearing a pair of Snow's trousers which clearly showed the difference in their heights. Cloth wrapped his ankles like loose elephant skin.

"I'm afraid I'll have to send for my man to bring some clothes. I can't walk down the Street in these, can I?" He looked down at the rumpled cuffs in folds around his ankles and began to laugh. Snow had forgotten to have the trousers cleaned since he last wore them; he caught sight of mud on the cuffs. Not the red clay of Golden Square, but a dry gray sediment. From the house by the river, with the dog pit.

Constable saw his gaze and lifted a leg to see. "Ah, I see your daily work takes you into the less scrubbed parts of London. You must not have looked much better than me the day you came home in these!" He laughed, but it sounded forced.

This threw Snow off. Just as before, he couldn't tell if Constable knew something. There was no more time, though, to wait. He had to be gone. He decided he didn't need any excuse to leave; the man must know he had to work.

Constable held his muddy shoes at arm's length with a questioning look. "By the door," said Snow. "The housekeeper will see to them. I'll have them sent to you."

As Snow tucked a stack of notebooks under his arm, he continued, "I've got to go. Mrs. Jarrett will see to your needs until your man arrives. I hope you've quite recovered."

"It was nothing. Thank you for your help."

"Good morning, then." Hate would have been so simplifying. It would have wrapped up all his uncomfortable emotions into a package as easy to take in as a pork bun from a street stall. But he found himself liking the man, and, even more troublesome, wanting his approval.

On his way out the door, Snow glanced down at Sir Philip's shoes. The tip of each one was white with dried salt.

3

The fresh early light was gone and now the day was bronzed and hot. Snow pulled the list from his pocket and out of habit looked over his shoulder. It was then that he remembered where he'd seen the man digging in the ditch. The day he'd passed the murdered man in Golden Square, the same man had been there, talking to that Inspector McGowan. He'd said he was the foreman.

And Snow remembered another thing that had struck him at the time but that he had forgotten because immediately after he'd seen Sir Philip at the riot. Behind the ditch, fenced off and roofed over, was a hole which hadn't been there before, with the top of a ladder poking out. A narrow hole, like something leading down into a tunnel. Snow had crossed the square hundreds of times in the past years and had never known a sewer entrance to be there.

For the first time it occurred to him that close examination of a sewer might tell him something about the water supply and cholera. He decided to go see the spot again. It was on his way. By now the crowds would probably be dispersed.

The tin roof and ladder were gone, and the hole was freshly turfed over with grass sod. Only the thin line of earth around the square edges gave it away. By the end of the day, when the earth dried out, it would be no different from the rest of the grass in the square. The work would have taken a man almost two hours, he thought. They must have started the moment the riot began.

Snow tentatively poked at the edge of the sod with his boot, until one of the diggers, back at work now, called out to him.

"‘Ey, guvnor, that area's off limits. You could ‘urt yourself." It wasn't the man who had been digging before. Snow looked at his watch and reluctantly left.

For additional details of Snow's professional life, including admission into the Royal College of Surgeons in 1838 and Royal College of Physicians in 1850, click here.